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The subsequent absence of ANA delayed the definitive diagnosis, which was ultimately established as ANA-negative systemic lupus erythematosus (SLE) based on comprehensive clinical criteria and multisystem involvement. This case presented a profound diagnostic dilemma, requiring not only the identification of a rare acquired FXIII deficiency as the cause of unexplained bleeding, but also the confirmation of SLE despite seronegativity, relying on its multisystem manifestations.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1791266","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T05:53:59Z","timestamp":1777442039000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A hidden cause of severe hemorrhage: a diagnostic and therapeutic challenge"],"prefix":"10.3389","volume":"17","author":[{"given":"Ziying","family":"Han","sequence":"first","affiliation":[{"name":"General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College","place":["Beijing, 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